Surrogacy has become both a popular and controversial solution for childless couples to create complete families; but exactly what is surrogacy?

Surrogacy is a fertility treatment in which a woman carries and delivers a pregnancy for another couple. This woman, the surrogate mother, may be the child’s genetic mother (as in the case of traditional surrogacy) or she may be genetically unrelated to the child (called gestational surrogacy). As part of the Surrogacy agreement, she waives all her parental rights and agrees to give the baby to the Intended Parents immediately upon delivery.

Surrogacy is gaining popularity all over the world, especially in western countries where adoption is tightly controlled through long, exhaustive bureaucratic processes. Adoption often takes years of waiting, whereas surrogacy on average requires about 14 months to complete. Surrogacy allows parents to not only take control of their own reproductive options, but also to create families that share genetic bonds. Children born through surrogacy are the natural, genetic offspring of their parents. This is a significant benefit over other reproductive options.

The first successful gestational surrogacy procedure took place in 1985, and it has been growing in popularity ever since. Other forms of surrogacy have existed since Biblical times, but the practice has only become highly publicized recently with popular celebrities announcing their surrogacy families, and with same-sex couples more actively pursuing family planning.

Women or couples often choose surrogacy because they are unable to conceive or carry a pregnancy to full term. Common reasons for pursuing surrogacy include a missing or abnormal uterus, multiple unexplained pregnancy miscarriages, multiple failed in-vitro fertilization attempts, or a health condition of the Intended Mother that would make pregnancy a health risk.

What is Surrogacy: A Glossary of Terms

Intended Parents: The person(s) who will eventually become the legal parents of a child born through a surrogacy arrangement. In most cases, the Intended Father is also the sperm donor and legal father upon the child’s birth. The legal status of the Intended Mother is often less certain. In countries without specific legislation, the Birth Mother is named on the child’s birth certificate, and she becomes the legal mother by default. In this case the Intended Mother may have to complete a court process (Adoption or “Parental Order” for example) to replace the birth mother’s name with her own.

Surrogate Mother (aka Gestational Carrier): A woman who has agreed to carry a pregnancy for another couple. As part of the arrangement the surrogate mother agrees to give custody and full parentage to the Intended Parents. Surrogate mothers may be compensated financially (as in the case of Commercial Surrogacy) or volunteer for the purpose of helping a childless couple conceive a family (as in the case of Altruistic Surrogacy).

In-vitro Fertilization (IVF): A clinical procedure whereby a human ovum (egg) is fertilized in a lab and allowed to develop into an embryo. Embryos conceived through IVF may be used right away, but are more often frozen and stored for use as part of a future fertility procedure (including Gestational Surrogacy).

Commercial Surrogacy: A surrogacy agreement in which one or more parties may benefit financially. For example, commercial surrogacy agreements often include significant compensation for the surrogate. Also as part of a commercial agreement, surrogacy agents often provide professional services such as recruiting surrogate mothers, providing professional oversight during the pregnancy, or managing the logistics of the surrogacy procedures. Many countries with explicit surrogacy laws prohibit commercial surrogacy on ethical grounds. Commercial surrogacy is legal in the United States, Ukraine, Russia, and some eastern European countries.

Altruistic Surrogacy: A surrogacy agreement where no party benefits financially. For example, in altruistic surrogacy agreements the surrogate is not compensated more than her own out-of-pocket expenses. Also commercial activities like advertising for surrogate mothers or providing professional care and oversight are not allowed. As a result of the limitations of altruistic surrogacy, it is often takes a long time to find qualified surrogate mothers, and once found the Intended Parents must provide much of the logistics that would be manged by professional services in a commercial surrogacy agreement. Countries with altruistic surrogacy laws include the United Kingdom and Canada, Belgium, the Netherlands and parts of Australia.

Traditional Surrogacy: A surrogacy arrangement where the surrogate mother is directly impregnated by the Intended Father. The surrogate may be impregnated through sexual intercourse or by intrauterine insemination (the injection of sperm into the woman’s uterus). Once the baby is born the surrogate agrees in principle to give the child to the intended parents and to waive all of her own parental rights. However in traditional surrogacy the surrogate is the genetic mother of the baby as well as the birth mother, and this is risky from a legal perspective as the Intended Mother has no biological connection to the baby or parental rights in most jurisdictions.

Gestational Surrogacy: A surrogacy arrangement in which the embryo is conceived through in-vitro fertilization and then transplanted into a surrogate mother. The surrogate will then carry and deliver the pregnancy. In most cases of gestational surrogacy, the embryos are conceived using the egg and sperm of the Intended Parents, and so they share a true genetic bond with the baby. In some cases an egg door may be used, but it is rare that a sperm donor is used in gestational surrogacy cases. To avoid any genetic relationship between the surrogate mother and the baby, the surrogate’s eggs are never used to conceive embryos in cases of Gestational Surrogacy.

With Gestational Surrogacy, the child born is genetically related to its parents and the surrogate mother has no genetic relation. The surrogate carries the baby to term, then gives up the child and waives any parental rights at birth.

Surrogacy Agency: A professional service that arranges and oversees surrogacy procedures. A surrogacy agency will provide full services, including recruiting and evaluating potential surrogate mothers, arranging clinical procedures, overseeing the surrogate during the pregnancy, arranging legal services in support of the surrogacy process, and providing support and counseling to the Intended Parents. In some cases surrogacy agencies are owned and operated by large Surrogacy Clinics, and thus have financial incentives to provide clinical services for their patron clinic. More reputable agencies are independent, work with multiple clinics, and receive no financial incentives to sell unnecessary or unwanted treatments.

Egg Donor: In many cases the future mother is unable to donate her own eggs, often for medical reasons. In these instances a donated egg may be used. Donated eggs are available through many international agencies, or the couple may ask a friend or family member to provide a donated egg. Donation agencies are a very reliable alternative, although the selection of an egg donor is best managed with an experienced consultant.

Why Choose Surrogacy?

Intended parents may arrange a surrogate pregnancy because of female infertility or other medical issues which make pregnancy or delivery impossible, risky or otherwise undesirable, or because the intended parents are both male. The intended parents may provide both the sperm and/or the eggs — but donor sperm, eggs and embryos are also often used.

The legality and costs of surrogacy vary widely around the world. In most European countries the procedure is prohibited or heavily restricted. In some countries, like the United Kingdom and Canada, ‘commercial surrogacy’ (where the surrogate mother is paid) is illegal while ‘altruistic surrogacy’ (where the surrogate mother volunteers the service and is only reimbursed for expenses) is permitted. In the United States, India and Thailand the process is legal and widely practiced.

Even where surrogacy is legal, the legal landscape varies greatly. In all cases a contract needs to be drawn up which should specify that the child becomes the legitimate adopted child of the intended couple. The couple, the surrogate and her husband will all sign this document.

Requirements for Gestational Surrogacy

Gestational Surrogacy can be achieved using the intended parents’ own egg and sperm. However is many cases donated eggs are also used. The requirements for a Gestational Surrogacy cycle depends on the specifics of each case.

Surrogacy with donated eggs:

If the father intends to donate the sperm he will need to visit the IVF clinic for up to five days to complete two rounds of sperm donation. Once the father’s donation is complete, the intended father is free to return home.

It typically requires 6 to 8 weeks of fertility treatments to prepare an egg donor. Stimulation treatment is designed to force the maturation of multiple eggs in the woman’s ovaries for retrieval and fertilization. During a woman’s natural cycle only one egg matures each month, a stimulation cycle can force the maturation of 15 to 20 eggs, making them suitable for fertilization. Once the donor has been properly prepared, she undergoes extraction using a large needle that harvests the eggs directly from the ovaries.

In-vitro fertilization happens immediately after the eggs are retrieved, and the fertilized eggs are left to grow for 5 days to monitor their quality. After 5 days the embryos have reached the blastocyst stage, and the embryos are generally frozen for future use. While the egg donor is undergoing stimulation, the surrogate can be prepared for the embryo transfer.

Healthy embryos, eggs and sperm samples can also be shipped internationally, potentially saving time and costs!

Embryo transfer takes place once the surrogate has been prepared through a fertility protocol to thicken her endometrium and boost her fertility hormones. Once she has been prepared, the embryos are thawed and transferred to her uterus.

Following implantation, IVF doctors continue to monitor the surrogate from 12 to 14 days. After the 2 weeks, a pregnancy test (also known as the bHCG) is performed to confirm that the IVF resulted in pregnancy.

Surrogacy with the intended mother’s eggs:

Women who will use their own eggs for the surrogacy process should expect to undergo about 15 days of daily fertility treatments before retrieving her eggs. Intended Mothers need to be in the clinic a few days prior to their menses so that the clinic can run some tests along with a physical examination. Stimulation of the woman’s ovaries (Gonadotropin Injections) will then be started at the beginning of her menses (determined after doing a blood hormonal test).

The mother will be required to take daily injections for about 14 days, during which multiple mature eggs will have formed in both ovaries. The Ovum collection will be around day 15, and the fertilization immediately after. The resulting embryos are typically frozen and the Embryo Transfer may happen at any point in the future.

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